Retrospective study identified fish and milk as the main culprits in cases of food protein‐induced enterocolitis syndrome

Douros, Konstantinos; Tsabouri, Sophia; Feketea, Gavriela; Grammeniatis, Vasilis; Koliofoti, Eleana Georgia; Papadopoulos, Marios C.; Sardeli, Olympia; Triga, Maria; Priftis, Kostas Ν.

doi:10.1111/apa.14779

Cited by 32 publications

(58 citation statements)

References 16 publications

(28 reference statements)

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“…CM, for example, is the most common trigger food in Italy, USA, and Greece, 31,32,33 confirming the results of our population; rice ranks first in Australia 33,34 and is becoming increasingly frequent in the USA. 29 Fish is prevalent in Mediterranean countries, i.e., Italy, Spain, and Gre ece, 31,35,36,37 but in our cohort, it was not as widespread as egg (19%). Similarly to Miceli Sopo S. et al's study, 38 also among our patients with FPIES to fish (n = 11, 13%), the main trigger fish was the sole (n = 8, 73%).…”

Section: Discussionsupporting

confidence: 86%

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Ballini

Gavagni

Guidotti

et al. 2021

aei

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Introduction and objective: The oral food challenge (OFC) is the gold standard to diagnose food allergy (FA); however, it is not a procedure free from the risk of having significant allergic reactions, even life-threatening.The aims of our study were to evaluate the frequency of positive OFCs performed in chil-dren with a suspected diagnosis of IgE- and non-IgE–mediated (food protein–induced enterocolitis syndrome (FPIES)) FA and how the failed challenges were managed.Materials and methods: A retrospective chart review was done on all children who have had OFCs in a tertiary-care pediatric allergy unit from 2017 to 2019.Results: 682 patients were enrolled and 2206 challenges were performed: 2058 (93%) for IgE-mediated FA and 148 (7%) for FPIES. There were 262 (11.8%) challenge failures. The transfer to the emergency department was required 3 times (1.1%). None of the failed challenges resulted in death or hospitalization and 13.3% challenges did not require any treatment.Conclusions: Our findings confirm that food challenges can be performed safely in a specialized setting by well-trained personnel; all food challenge reactions, even the most serious, were reversible, thanks to a prompt recognition and treatment that generally did not worsen over time.

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Section: Discussionsupporting

confidence: 86%

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Ballini

Gavagni

Guidotti

et al. 2021

aei

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“…Soya‐induced FPIES is especially frequent in Korea, often associated with CM‐FPIES (up in 43% of patients), but it has a better prognosis and an earlier resolution than in other countries 16 . Fish is one of the most common offending triggers of FPIES in Southern Europe 5,17‐19 and appears to have a poorer prognosis than other foods. Vazquez‐Ortiz et al reported an average age of resolution for fish‐induced FPIES at 60 months, concluding that FPIES to fish resolved over time in most cases, with a 75% cumulative probability of resolution at around 5 years 6 …”

Section: Discussionmentioning

confidence: 99%

Poor prognosis of food protein–induced enterocolitis syndrome to fish

Infante

Perez-Pallise

Skrabski

et al. 2021

Pediatric Allergy Immunology

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Background: Fish is the most common causative food of food protein-induced enterocolitis syndrome (FPIES) in Southern Europe. In children with FPIES, the development of tolerance varies according to the culprit food and specifically fish seems to have a poorer prognosis than other solid foods. We sought to evaluate the fish-FPIES resolution rate in children. Methods: A descriptive retrospective analysis of children with fish-FPIES, followed during the last 20 years, was performed. The offending fish, age and symptoms at onset, the coexistence of atopic diseases and FPIES to other foods were registered. All the children included had undergone an oral food challenge (OFC) with the offending fish. We recorded those children that overcame their fish-FPIES and those that did not outgrow the disease. Results: Seventy children were enrolled in this study (median age: 9 yo; IQR 6.4-13.8). Forty-two (60%) achieved tolerance to the offending fish with a median age of 4 years (IQR: 3-5). Among children ≤5 yo (n = 40), 35 (87.5%) developed tolerance; among 6-8yo (n = 14), 40% developed tolerance; and only 12.5% among those ≥9 yo (n = 16) developed tolerance. Twenty-eight children did not outgrow the disease (median age: 8.9 yo; IQR: 9-13.8). We did not find any statistical differences regarding the offending fish, presence of single vs multiple fish-FPIES, symptoms at the beginning, coexistence of other atopic diseases or the coexistence of other FPIES, between the children who overcame the disease and those who did not. Conclusion: One in five children with FPIES to fish will not overcome the disease during childhood.

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“…6 Resolution of FPIES to fish is around 18.8% to 57.0% of cases between 3 to 4.5 years of age. 13,16,22,23 We found a similar rate of 38% tolerance at 4.0 years of age, with an older age of resolution for fish than CM. Due to the low prevalence of multiple FPIES in our cohort, we were unable to compare the age of resolution of single and multiple FPIES.…”

Section: Discussionmentioning

confidence: 56%

“…In our study, the main culprit food was CM, followed by hen's egg, and fish, which differs from the findings in other countries. [7][8][9][10][11][12] The most frequent culprit food was fish in Greece 13 and Spain 10,14 rice in Australia [15][16][17] and the USA, 18 and oats in Taiwan. 19 Soy is frequently reported as a trigger food by North American, British, Australian and Israeli cohorts 4,17,20,21 and was infrequent in our population.…”

Section: Discussionmentioning

confidence: 99%

Food protein-induced enterocolitis syndrome: a large French multicentric experience

Lemoine¹,

Colas²,

et al. 2021

Preprint

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Background Food protein-induced enterocolitis syndrome (FPIES) is a non IgE-mediated food allergy, with potential dehydration secondary to vomiting. Differences exist regarding culprit foods, onset symptoms, and age of tolerance depending on the country of origin. We aimed to describe the characteristics of a French population of children with FPIES. Methods Data from 179 children who were referred for acute or chronic FPIES in two pediatric tertiary centers between 2014 and 2020 were retrospectively collected. The diagnosis of FPIES was based on international consensus guidelines. Clinical characteristics, culprit food and age at resolution were assessed. Results In the 192 described FPIES, the age at first symptoms was 5.8 months old. The main offending foods were cow’s milk (60.3%), hen’s egg (16.2%), and fish (11.7%). Single FPIES was observed in 94.4% and multiple FPIES in 5.6% of cases. The age at resolution of FPIES was 2.2 years old, and resolution occurred later for fish than for milk (2.9 years versus 2.0, p=0.01). Severe acute FPIES was a risk factor for delayed resolution (relative risk: 3.3 [1.2-9.2]), but not IgE sensitization. Performing an oral food challenge within 12 months after the first reaction increased the risk of failure (RR: 2.0 [1.2-3.5]). Conclusion In this French cohort of children with FPIES, the main culprit foods were ubiquitous. Rice, oat and soy were rarely or not involved. Multiple FPIES was infrequent. Our data confirmed the overall good prognosis of FPIES, the later resolution of FPIES to fish and in the case of severe acute FPIES.

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Retrospective study identified fish and milk as the main culprits in cases of food protein‐induced enterocolitis syndrome

Cited by 32 publications

References 16 publications

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Frequency of positive oral food challenges and their outcomes in the allergy unit of a tertiary-care pediatric hospital

Poor prognosis of food protein–induced enterocolitis syndrome to fish

Food protein-induced enterocolitis syndrome: a large French multicentric experience

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